Dr Stuart Farrimond

Survey reveals that reality is more positive than some believe

WE’RE rapidly running out of chocolates in the Advent calendar. The big day is looming, when we look forward to a morning of wrapping paper chaos followed by an afternoon of wine, turkey, Brussels sprouts, and boozy pud.  Already, some people are starting to worry about how big their gut will be after the seasonal gluttony and Lifestyle magazines and glossy newspaper pull-outs are offering ‘Christmas diet’ tips but, as with all things that demand willpower, a ‘quick-fix’ is only a mouse-click away.  A little over a week ago, a nationwide survey of 1,800 slimmers revealed that an astonishing one in three have bought weight-loss pills online. Promising an effort-free way to shed the pounds, people who buy these miracle medicines are quite possibly biting off more than they can chew. There is no trickery: Losing weight is a simple maths. Eat more food than your body needs and you will put on fat; eat fewer calories than your body burns and you will shed weight. Depending on how much you exercise, women generally use about 2,000 calories a day and men around 2,500 calories. If ‘slimming pills’ are to help you lose weight then they must: increase your metabolic rate (the number of calories you burn in a day), lower your appetite, or stop your intestines from absorbing food normally.  I did an online search to find out how easy it is to buy weight-loss pills. By far the most popular type of slimming pill sold online are ‘fat burners’, which claim to fire up your body’s metabolism. Nearly all are completely untested and slip under the radar of the law because they call themselves ‘supplements’.  In reality, they range from doing next-to-nothing, to causing headaches, palpitations, diarrhoea, to mental health issues, to poisoning your internal organs.  ‘All-natural’ or ‘herbal’ is reassuring, but does not mean ‘safe’, and might even disguise a pill that contains frighteningly high doses of caffeine or one of many chemicals that can do serious damage.  There is a raft of herbal remedies that can affect you like amphetamines (‘speed’). It really is no wonder that hundreds of people end up in hospital every year after gulping down such unregulated ‘slimming aids’.  I was horrified to discover just how simple it was to buy weight-loss medicines. Not only is there nothing to stop children buying them, but many pills and potions don’t even list their ingredients. Very few websites gave any warnings about side-effects or dangers. If these pills really do anything at all, then they will have potential side-effects and risks and so must carry warnings.  The MHRA (Medicines and Health Regulatory Agency), whose job it is to monitor medicines in the UK, is now spearheading a crackdown on these dodgy drugs and has launched its #fakemeds campaign.  The government body has already shut down thousands of websites and seized crate-loads of suspect slimming pills. Among its haul are 28,000 ‘natural’ ‘Aduki Diet’ pills from a retailer in Manchester, which they discovered were laced with a banned appetite-lowering drug called sibutramine. Each capsule was a lethal cocktail, and taking one would be playing Russian Roulette with sudden death.  To help us out, the MHRA website gives useful advice before buying online (search for ‘fakemeds’). Their online portal lets you search to check whether an online retailer is legitimate and gives you option to report side-effects or suspect tablets.  There are currently no licensed ‘slimming pills’ in the UK, but there are medicines that a doctor can prescribe to help if you are clinically overweight or obese.  Speak to your doctor before dabbling in slimming pills – they won’t think you foolish. They can offer advice, reduced fee gym memberships and, if you really are overweight or obese, have the option to prescribe tablets that are proven to be safe.  These drugs reduce how much fat your body can absorb from food and may work when taken alongside a sensible diet and regular exercise.  Never trust the ‘guaranteed weight loss’ hype or listen to ‘Becky’ who says: “I lost 7lbs in just 12 days”.  If it sounds too good to be true, then it almost certainly is. There is no such thing as a free lunch. 

YOU might want to get that cough of yours checked out. Yes, the weather is taking a turn for the worse and sniffy germs are going round faster than news about a royal marriage, but If you’ve been battling a cough that just won’t shift, then please do not ignore it. Of all the diseases not to get, lung cancer ranks near the top of the league table of all-time-most-horrible illnesses. A third of people who are diagnosed with lung cancer will die within 90 days and – to rub salt into the wounds – those who are afflicted often live beneath a stigma of shame.  Most cancer patients are seen as innocent victims to life’s cruel roll of the dice, but lung cancer patients are seen as ‘guilty as charged’ for their “selfish” nicotine addiction. You might not say it, but The lurking belief among many of us is: “It’s your fault, you knew the risks of smoking!” This must change. Breast cancer and leukaemia get all the headlines but lung cancer is still the UK’s biggest cancer killer. In the words of one lung cancer patient: “I’ve been given a death sentence, but it’s my own fault. I didn’t realise why my cough was getting worse, and neither did my GP.  But anyway, I don’t deserve to be treated because I brought this on myself.”  Some lung cancer patients even tell their friends and family that they have a different type of cancer, such is the blame they feel.  One of the greatest tragedies of this grim disease is that if it is caught soon enough then it can often be cured. But given lung cancer is seen as “your fault”, it’s hardly surprising that many smokers and ex-smokers would rather bury their heads in the sand than go see a doctor. It can be difficult for a doctor to spot but A simple chest X-ray will typically give all the answers.  A report published three years ago in the British Medical Journal found that patients who died from lung cancer had visited their GP an average of five times in the months before diagnosis.  Thankfully, guidelines have been updated. You’ll be sent for an urgent chest X-ray if you’re a smoker or ex-smoker, aged over 40 and have had a cough, fatigue, shortness of breath, chest pain, weight loss, or appetite loss. If you ever cough up blood, then don’t even blink before booking an appointment with your doctor. Lung cancer treatments have come a long way in recent years – something else you never hear about. Ann Long is now 81 years old and was diagnosed with lung cancer: “I would urge anybody with symptoms that might be lung cancer, like a persistent cough, to see their doctor straight away. I’m glad I did. I was diagnosed with lung cancer in 2003 and I can still do all the things I did before my treatment, like long walks, swimming and spending time with my family.” Even if you are a smoker chances are that you will get the all-clear – but that’s not a reason to put it off. If you suspected your car was leaking petrol then you wouldn’t think twice about getting it down to the garage, would you? It is true that most people who get lung cancer have smoked at some point there’s little point in playing the blame card. Much-loved TV personality Roy Castle never smoked. Many cancers are partly caused by lifestyle choices, such as how much we fruit and veg we eat, what we do for a job, how much we exercise, how much we drink, how much time we spend outdoors, how much polluted air we breathe in, and whether we are overweight  The bottom line is simple: If you’ve had a cough for two weeks or more and have ever smoked then get it checked out. No blame.   

DOCTORS recently celebrated the 40th anniversary of the moment Louise Brown entered the world. Most of us are brought into the world through the intimate union of mum and dad, but Louise was the world’s first ‘test tube baby’. Her arrival was an earth-shattering breakthrough like something from a sci-fi story. Mr and Mrs Brown’s sperm and egg had been mixed in a shallow Petri dish (not a test tube) and left for a few days until grown into an embryo the size of a grain of sand, then injected into mum’s womb. Louise was born nine months later. For 1978, it was a mind-boggling advance, but like most human endeavours, it hadn’t come out of the blue. Some people say the Great Pyramid of Giza fell from the sky when actually it was the crowning glory of hundreds of years’ technological progress (no one remembers the botched attempts that crumbled). Similarly, IVF (In-Vitro Fertilisation) was the product of years of blood, sweat and tears. Newspapers proclaimed Louise the “Superbabe” who gave “new hope for motherhood” and the world will never be the same again. Millions of infertile couples now have a hope their grandparents’ generation could have only dreamed of.  I BELIEVE that we have just witnessed another medical breakthrough more monumental than IVF, which burst on the world 40 years ago with the birth of Louise Brown, meaning millions of infertile couples now have a hope their grandparents’ generation could have only dreamed of. We learnt of a seven-year-old boy – the ‘boy with the butterfly skin’ – whose life was saved with cutting-edge genetic engineering treatments. Born in war-torn Syria, Hassan came into the world with a rare genetic condition called epidermolysis bullosa. It caused his skin to be as delicate and brittle as a butterfly, making it slough off or blister at the slightest touch. Forget playing football or having anything approaching a normal childhood – his body was a mess of disfiguring and agonising sores. All doctors could do was delay the inevitable – until now. 21 months ago, Hassan received a treatment called ‘autologous transgenic stem cell treatment’ (they’re going to need to work on a better name). Hassan was in intensive care after having lost 80 per cent of his skin and looking like he had been dropped into a vat of boiling water when medics plucked up the courage to try something new. Embarking on a brave new venture, they found and snipped out a 4cm square (0.6 sq inches) of skin that hadn’t yet blistered to take to the lab for some genetic jiggery-pokery. They mixed his skin cells with a genetically-modified virus that had been programmed to infect the cells and correct the boy’s genetic error. Now if that wasn’t space-age enough, they then grew his skin cells on a glass plates – for about the same amount of time Louise Brown lived in a Petri dish – until they had manufactured sheets of brand new skin. Looking like transparent, squidgy paper, this new skin was as fresh as a newly-born babe’s. After layering it back onto Hassan’s beetroot red body, he was quite literally reborn. Hassan can now run around and play football, and is beginning to have a real childhood – I challenge you to take the time to read Hassan’s full story and not shed a tear. His story marks the new era of genetic therapies that I believe will see many diabolical diseases become a footnote of history. Don’t believe me? A little over a week ago, a 44-year-old American man who was born with a debilitating condition called Hunter’s Syndrome became the first person to be treated with ‘total-body’ gene therapy. If all goes according to plan, every strand of faulty DNA in his body will be fixed and he will be completely cured. Watch this space – if you thought IVF was incredible, you ain’t seen nothing yet.

TELLING my story isn’t always easy. Last Friday I gave an blow-by-blow account of life in the shadow of cancer. Describing the gritty details of learning I had a brain tumour ten years ago, developing epilepsy, leaving hospital practice and suffering deep emotional lows doesn’t exactly fill you with the joys of spring.  Yet sharing my journey to a near-complete stranger in my living room was a necessary evil. From my blackest times might come something that has a brighter purpose, because the woman who furiously scribbled down my words was on a mission to improve the lives of those who are to face a similar cancer battle. Emma, my interviewer, works for All.Can. (Not a great name, I know.) It was set up to reduce waste and streamline cancer care in the UK and, eventually, across all of Europe. It sounds like a bureaucratic goal but all cancer patients and anyone who has had a ‘cancer scare’ will know that little things can make a big difference.  In the UK today, getting results, attending treatments, getting hold of decent information and finding support can sometimes be painfully drawn-out. Making just some of these things easier will ease stress and save unnecessary expense. Let me give you an example from my own experiences. Why must I take a half-day off work every six months to traipse over to Bristol so that I can lie in a scanner for 40 minutes, only to be sent home and told to wait at least two weeks for the results? Come ‘results day’, my wife and I need to take another half-day off work so that we can drive into the city, fight for a parking space, and get worked up waiting anxiously for a consultant appointment. The stressful delay we long-term cancer patients must endure is simply because our images are sitting in a radiology doctor’s ‘non-urgent’ pile of work. Analysing an MRI, CT, X-ray, or ultrasound scan usually takes a radiologist no more than 15 minutes – but it only gets seen when they carve a few moments out of their hectic schedules to look at it. As I bared my soul to Emma, I said that Surely it is not beyond the wit of the NHS powers-that-be to get everyone singing from the same hymn sheet? The radiographers, nursing staff, radiologists and cancer doctors could all be timetabled to spend specific days working just with cancer patients. A radiologist could look at scan images as soon as the patient has clambered out of the MRI or CT machine and the results passed on to the oncologist (cancer doctor) without delay.  Within an hour the patient could be sitting down with the consultant to chat about what the results showed. The whole gig could be done and dusted within a couple of hours. This would mean no need for: two visits to the hospital, two days off work, two stressful hunts for a parking space, two lots of reception staff, and two sets of appointments to book. Importantly, there would also be no more stewing on what might – or might not – be for two weeks. It’s a win-win solution that saves time, money, and stress, which is especially important at a time when the NHS’s precious resources are being stretched to near breaking point. This is just one example of sensible thinking to for an often overly-complicated system. All.Can will be petitioning the Government to streamline cancer care and can be found online at all-can.org. It will be launching the first ever patient survey on waste and inefficiency in cancer care online in early 2018. To be alerted to when the survey goes live, follow them on twitter @AllCanGroup or on Facebook at: facebook.com/AllCanGroup . You can also sign up to the newsletter via the website. Many time- and money-saving solutions are utterly obvious – I know only too well that doctors who are in the NHS machine can sometimes find it difficult to see the wood for the trees. It is the likes of you and I, who receive treatment, who can point out what can be done better – no doubt many readers will have lots of ideas.  Thankfully, you who sit on the receiving end of the healthcare system have a chance to have your voice heard (see links below). I’m sure any cancer patient will agree with me that any opportunity to bring a silver lining from our darkest times needs to be grabbed with both hands.

FOR many of us Mondays feel like a sleep-deprived haze. A third of us admit to feeling ‘unusually tired’ at any given time; which is hardly surprising given that a third of Brits get less than six hours sleep a night, which is far less than the recommended eight hours needed to properly rejuvenate body and mind. But for some people, even a good night’s sleep doesn’t refresh them.  At least 1.5 million Britons are living in perpetual tiredness due to a sleeping disorder that puts their lives at risk – and the lives of others around them. Called obstructive sleep apnoea (or OSA) this condition causes morning headaches, poor concentration and memory; moodiness, low sex drive, anxiety and depression. People with OSA are forever exhausted and can nod off at the drop of a hat. And although this might be great if having to sit through a boring movie, it causes frequent lapses of concentration throughout the day. OSA means you will easily doze off behind the wheel and every year about 40,000 road traffic accidents are caused by OSA. Worryingly, Most people don’t know when they have it. OSA is caused by floppy muscles in the neck. It tends to affect people who snore at night, are overweight, and/or have a large neck. When we fall asleep at night, all our muscles naturally relax, including those around our windpipe. If you have OSA then the throat muscles simply aren’t strong enough keep the windpipe open and so the weight of the neck squashes the airway. People with OSA will usually snore loudly before momentarily choking. They wake up with a splutter and then drift off again. It can happen dozens of times a night, but the episodes are so brief that most people with OSA don’t remember them happening. Not only do people with OSA wake up feeling unrefreshed, but their fragmented sleep takes a toll on their inner workings. Hormone levels are knocked off kilter and the chances of diabetes, heart attack and stroke are increased markedly. In fact, if you have type 2 diabetes then chances are that you already have OSA – more than 80 per cent of people with diabetes do. Perhaps most troubling is what happens to the mind. Starved of a good night’s sleep, people with OSA dip into moments of ‘microsleep’ in the day. Microsleep can last less than a second and it is so short the brain doesn’t register it, meaning you are utterly oblivious to having dozed off. In fact, if you tell someone after they have just had a microsleep then they simply won’t believe you. OSA sufferers have bouts of microsleep when sat waiting in stationary traffic, but it doesn’t take a genius to work out what might happen if they go into microsleep when operating heavy machinery or driving a lorry. If you snore at night, continuously feel sleep-deprived, or find yourself waking up with a start by cars hooting at you when the lights turn green then consider summoning the energy to visit your doctor. Panic not though: modern medicine means that OSA needn’t be a nightmare. Lifestyle changes, mouth guards (called mandibular advancement devices) and specialised ‘CPAP’ sleeping masks can often completely cure the problem. Getting it treated will improve your overall health and – who knows? – maybe a good night’s kip will make life seem a whole lot better.

WE all know someone who worries far too much about their health. You know the type: they think they’re dying when they have a sprained ankle and worry that a tummy ache is a parasitic worm.  Health anxiety – better known as ‘hypochondria’ – blows up frivolous aches and normal bodily functions into apocalyptic omens. A hypochondriac might be in the prime of their life and may well run marathons every weekend, but their mind is preoccupied with fears that a major medical event is lurking around the next bend. For people with health anxiety, life can seem like the 1975 Jaws movie poster. Hypochondriacs fear death and disability from an impending medical monster – and are desperate not to be an unwitting victim like the naïve naked swimmer. Hypochondria isn’t new and is surprisingly common. The word ‘hypochondria’ means ‘the area underneath the ribs’ because doctors used to think was a problem in the organs rather than the mind.  In the 1600s, some doctors said that half of all their patients suffered an unfounded belief in a serious illness. Today UK researchers think that up to a fifth of general practice and clinic appointments are due to excessive worry about health. The internet has fuelled an increase in health anxiety and is the terrifying playground for hypochondriac. Research shows that we Google our symptoms even before we tell our partner, and one in four Brits go so far as to diagnose themselves from their internet rather than see a doctor. ‘Cyberchondria’ is particularly dangerous because of the countless poor quality, scaremongering websites. Most people don’t check the quality of the websites they read:  Recent research by scientists in Boston, USA, found that online symptom-checkers only get the diagnosis correct a third of the time. But we shouldn’t just roll our eyes when a friend tells us they’re worried about their headache for the umpteenth time, despite having been repeatedly given the all-clear by doctor. Heath anxiety means continually seeking information and reassurance about symptoms, which sets up a vicious cycle of worry.  Hypochondriacs want complete assurance and certainty about their health – something that is impossible. Nevertheless, if you dismiss a health worrier’s concerns out of hand then you can fuel their fears that a deadly predator lurking in their loins. Constant checking of a body part and searching online takes a real emotional toll. Many people with hypochondria also have underlying depression, anxiety disorder, or other mental health issue. If you suffer health anxiety, then know that repeated checking amplifies fretting. Be prepared to confront your fears, possibly with the help of an experienced counsellor. It is worthwhile avoiding empty reassurances.  Instead, find out the facts and consider the odds: brain tumours affect very few people – just 0.002 per cent of us. (You wouldn’t know that from Google, where 25 per cent of all search results for “headache” point to brain tumour as a potential cause.) A little information is dangerous, so arm yourself with the real facts through patient leaflets from your surgery or trustworthy websites, such as NHS Choices.  This Monday, Macmillan Cancer Support joined the fight against ‘fake news’ by appointing a ‘digital nurse’ employed to give trustworthy advice to anyone who shares their concerns on their site at community.macmillan.org.uk. In the famous image, a naked woman is joyfully swimming in the sea and beneath her, a huge great white shark with huge white teeth is surging up to eat her. The scene is horrifying, not merely because she is about to become fish food, but because she is so blissfully unaware – had she known that there was a shark on the prowl then she would never have entered the waters! 

Level of palliative care affects not just the patient but families too

WHEN I was a child, going out for a meal was a special treat. In the mid-80s, most restaurants didn’t have kids’ menus: they simply served up a child-sized portion of whatever Mum and Dad were having. The McDonald’s Happy Meal had not long been catapulted onto our shores and – thanks to a barrage of television advertising – my eight-year-old mind could imagine nothing more gastronomically satisfying than a paper bag containing burger, fries and a plastic toy. Aware of its reputation for being ‘junk food’, my parents vowed to never let me have a Happy Meal, despite much blubbering and begging. Today almost all big chain restaurants offer food tailored to children. A brightly coloured kiddie menu comes complete with tiny crayons and a colouring sheet. This is great for avoiding tantrums and getting kids involved, and you would imagine that most restaurants serve up nutritious fare to go with the cartoon cucumbers. Given everything we know about healthy eating, and the dangers of a ballooning childhood obesity problem, the actual reality is depressing: a few carrot sticks pushed in next to a pile of chips, chicken nuggets and a dollop of tinned spaghetti doesn’t quite cut it.  Kids’ meals have not always been bags of greasy stodge. The American fast food companies didn’t invent the children’s meal – the idea had far more savoury beginnings. Bizarrely, American pub owners first invented children’s menus in the 1920 during prohibition. Unable to make money from selling liquor, bars up and down the States devised children’s meals to try to coax families in. Back then, feeding youngsters was all about affordable nutrition. The standard child’s meal was a simply broiled cut of meat, served with vegetables and/or rice. Desserts were similarly unflamboyant and lemonade to the under-10s was strictly forbidden. Fast-forward to 2017, and many restaurants offer kids free refills of sugary pop, fries with everything, and one well-known pizza restaurant chain still boasts an all-you-can-eat ‘ice cream factory’. For the past two years, the Soil Association has dispatched ‘secret shoppers’ to rate major restaurant chains on the quality and healthiness of their children’s menu offerings. Burger King was ranked bottom, scoring a pitiful score of 11 out of 80. KFC, Pizza Hut, Nando’s and Hungry Horse weren’t far behind, all being shamed as promoting uninspiring greasy and sugary kids’ fodder. It’s not just lack of greens that is the problem but portion size. At Harvester, for example, a kid’s size cheese hamburger with a side of sweet potato fries and a ‘healthy’ fruit smoothie clock up nearly 1,000 calories. And that’s before you add in a dessert. Children aged between four and eight need no more than 1,400 calories a day – and that’s only if they’re fairly active.  If family outings were a rare treat then a plate of indulgence wouldn’t be such a bad thing but this is no longer the 1980s. Today, a third of families eat out at least once a week, and every year we Brits spend more on meals out.  Mercifully, public pressure is forcing the big-profit establishments finally treat kids’ diets with the respect they deserve.  Nevertheless, It is a good idea for parents to be cynical of any super-cheap kids’ meals: do a quick internet search to check out a restaurant’s nutritional information before taking the family. And if all else fails, then ignore the hot-dogs and breadcrumbed bits – just pick something nice and order them a smaller portion of whatever you’re having.

Opium-based pills are now killing more people in US than gun crime